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We present three cases of eosinophilic granuloma of the ilium in children. Imaging investigations (computed tomography and magnetic resonance imaging) did not elucidate the disease but rather revealed patterns more like malignant tumours than a benign condition. However, these investigations were of value in directing the surgeon to the correct site for biopsy.
A patient presented with pain in the right lower back, radiating down the right leg. Initial pelvic X-rays did not reveal any lesion. A follow up computerized tomography (CT) scan and technitium scan showed a sharply lytic lesion of the right ilium extending to the right sacroiliac joint. Open biopsy revealed a granulomatous inflammation with many budding yeast from consistent with Blastomyces dermatitidis. Subsequent culture confirmed this identification. There was no other site of fungal infection. Two courses of Amphotericin B (each to 2 g total dose) failed to eradicate this infection. The patient is now responding to Ketoconazole.
In crude homogenates prepared from freeze-dried cryostate sections of various rat organs the Km and Vmax of acid and neutral alpha-glucosidase as well as the effect of the pH, substrate and enzyme concentration and the incubation time on the activity were determined fluorometrically with 4-methylumbelliferyl- and 2-naphthyl alpha-d-glucoside as substrates. On the basis of the biochemical data 2 assays were developed for the microchemical measurement of both alpha-glucosidases in groups of epithelial cells isolated from freeze dried cryostate sections of the epididymis, jejunum, ilium, liver and kidney of suckling and adult rats. The rate of hydrolysis of 2-naphthyl and 4-methylumbelliferyl alpha-d-glucoside differs moderately. However, due to the higher sensitivity of 4-methylumbelliferone the methylumbelliferyl derivative is preferable especially for the evaluation of alpha-d-glucosidases in cells with low enzyme activity.
For experimental studies of bone in dogs it may be necessary to collect from the iliac crest biopsies of a larger diameter than is usually obtainable. A disadvantage of using a trephine with a large bore is that the biopsy may be pulled out of the trephine by the forces exerted by tendons inserted in the medial cortex of the ilium. To overcome this difficulty we developed a trephine with an internal bore of 10 mm combined with a biopsy-fixing attachment.
The development and introduction of microsurgical technique has made possible completely new concept of revascularisation surgery in femoral head necrosis. The bone graft described in this presentation is a pedicled one from the lateral ilium. In five femoral head necrosis a pedicled corticocancellous pelvic graft, supplied by the deep branch of the superior gluteal artery, was transplanted in the femoral head. In all cases it was possible to lift out the pelvic graft from the same side as the affected hip joint. Contrary to the medial iliac bone graft (deep circumflex iliac artery) the lateral iliac bone graft (deep branch of the superior gluteal artery) is inserted into the femoral head dorsally. Preoperatively and postoperatively performed selective angiographies are necessary and presented. In all cases an unimpeded perfusion could be shown three months postoperatively. Advantages and indications of the pedicled bone graft are discussed.
Unexpected iliac uptake of 99mTc-DTPA was noted in a 10-year old female referred for evaluation of renal function prior to receiving chemotherapy for relapsed acute lymphocytic leukemia. This scan finding corresponded to the site of a bone marrow biopsy performed five days earlier. X-ray of the area revealed no abnormality. It is assumed that the extrarenal uptake was due to increased vascularity at the site of recent bone marrow biopsy, most likely due to increased osteoblastic reaction in the cortex of the ilium. The patient proceeded with the bone marrow transplant and was well at follow-up six months later.
In this study the outcome of autologous bone cell transplantation in artificial femur defects was tested within an animal study in sheep. The bone cells were harvested by a small ilium biopsy and cultivated in an individual medium with 10% autogenous serum and 90% X-Vivo 10. After two weeks 4 millions of the cultured bone cells were transplanted in artificial femur defects with bone gelatin as carrier. The remaining cells were characterized by various tests (Alkaline phosphatase, osteocalcin, collagen type I, calcification). This procedure was tested in 24 adult male sheep. The side of transplantation was randomized by plan. The corresponding femur side represents the control side. After 10 days, 4, 8 and 12 weeks animals were killed and the femura were taken for the following evaluation: histology, radiology, bone density and mechanical testing. The results show that the autologous bone transplantation leads to a significant higher bone regeneration in the bone defects. After ten days there was a lower migration of inflammation cells. After 4 weeks we find a significant increase of new bone formation on the transplanted side in the histological examination. After 8 weeks this significant difference was found even in the bone density. This difference increased in the 12 weeks group further on. The autogenous bone cell transplantation in the described way seems to be an potent method in the treatment of bone defects.
Within an experimental trial the new method of fluoroscopy based navigation was tested for percutaneous pelvic screw fixations. A regular C-arm was used and the navigation system developed by Medivision. In a first step appropriate C-arm projections were defined for five standardized screw positions. Then precision and fluoroscopy time of 60 screws in 6 artificial pelves were evaluated. For the sacroliacal screw in S1, S1 screw in S2, anterior column screw, posterior column screw and the supraacetabular ilium screw three to four appropriate projections were defined. These were all combinations of the known special pelvic views inlet/outlet and iliac/obturator. Using these standardized views the average fluoroscopy time was 6 seconds per screw. 51 screws (85%) were inserted correctly. In five cases there was a slight deviation without perforating the cortex, four times the cortex was perforated.
Various therapeutic options have been proposed in the treatment of femoral head necrosis ranging from conservative management to total hip arthroplasty. Since microsurgical techniques are routinely used in orthopaedic surgery, the importance of revascularization has increased in recent years. Vascularized bone grafting as well as various osteotomies have been considered for the stages II and III according to Ficat and II, III and IV of the criteria of the ARCO system respectively, which also bases on MRI-findings. We investigated the results of 80 patients with avascular necrosis of the femoral head treated with a vascular pedicled iliac bone graft, perfused by the A. circumflexa ilium profunda, between 1988 and 1996. Mean follow-up was 5.6 years. The evaluation was based on the harris hip score, clinical and radiological examination as well as a subjective assessment using a VAS (visual analog scale). The clinical results according to the harris hip score were good or excellent in 86.1%. These results correlate with the subjective assessment of pain and of the hip joint function with an average of 7.9 points using the VAS (max. 10 points). Unchanged radiological appearance over the follow-up period was observed in 47.5% using the ARCO criterias. Reviewing the studies using vascularized grafts, about 50% of the patients with a stage II and III according to Ficat and II, III and IV of the ARCO respectively show an unchanged stage of the disease 5-6 years after the procedure. Therefore, transplantation of a vascular pedicled iliac bone graft possibly offers the chance to intervene causally in the course of the disease with only little alteration of the biomechanics of the hip joint.
Fibrocartilaginous mesenchymoma of bone is a rare primary neoplasm. Our literature search produced only 12 previously reported cases. Radiographic and computed tomography (CT) findings have been described, but the magnetic resonance imaging (MRI) appearance has not been reported previously. We report a patient with fibrocartilaginous mesenchymoma of the ilium and describe the imaging findings on conventional radiography, bone scan, CT, and MRI.
Myxoma/fibromyxoma of extragnathic bone is a rare, benign tumor. We report the case of a 19-year-old man with a myxoma/fibromyxoma of the pelvic bone, who presented with abdominal pain in the right lower quadrant. Radiographs demonstrated a tumor with central scattered calcifications and ossification in the left ilium. CT scans disclosed a solitary ellipsoid tumor with sclerotic borders and no evidence of cortical disruption. MRI showed homogeneous signal enhancement of the bone marrow with slight thinning of the medial iliac cortex. Final diagnosis by radiological characteristics was not conclusive and histopathological examination suggested the diagnosis of a myxoma/fibromyxoma.
Xanthoma is a lesion containing abundant foamy histiocytes most commonly occurring in superficial soft tissues such as skin, subcutis, or tendon sheaths. The involvement of deep skeletal structures, however, is rare and has only been infrequently reported in the English literature. Most xanthomas occur in patients with hyperlipidemic disorders. We report a case of a xanthoma in the sacrum and ilium of a patient with hyperlipidemia type IIa, who had chronic lower back pain for more than 20 years. On radiographs the lesion appeared multiloculated and osteolytic with a thin sclerotic border and containing multiple nodular calcifications within its matrix. Computed tomographic images revealed a presacral soft-tissue mass that also infiltrated the adjacent sacroiliac joint and iliac fossa. On histologic examination, abundant areas of xanthoma cells and cholesterol clefts, typical of xanthoma, were present. The patient received simple curettage of the lesion, and his symptoms were markedly relieved.
Chronic expanding hematoma is a rare presentation of a hematoma characterized by a persistent increase in size for more than a month after the initial hemorrhage. We present a 65-year-old man with a chronic expanding hematoma in his ilium who was receiving anticoagulant treatment. The patient had a delayed manifestation of a femoral neuropathy with massive bone destruction. 2-Deoxy-[18F]fluoro-D: -glucose (FDG) positron emission tomography (PET) imaging revealed an increased uptake in the rim of the mass in images acquired 1 h after FDG injection. FDG-PET scans were performed using a dedicated PET scanner (HeadtomeV/SET2400 W, Shimadzu, Kyoto, Japan), and the PET data for the most metabolically active region of interest (ROI) were analyzed. The maximum standardized uptake value (SUVmax) was set to a cut-off point of 3.0 to distinguish between benign and malignant lesions. The SUVmax of the patient's lesion was 3.10, suggesting a malignant lesion. The characteristics of FDG-PET images of chronic expanding hematomas, including the uptake of FDG in the peripheral rim of the mass as a result of inflammation, should be recognized as a potential interpretive pitfall in mimicking a sarcoma.
The effect on intraosseous bone formation of a single local injection of recombinant human basic fibroblast growth factor into trabecular bones was examined in ovariectomised osteoporotic rats. Fibroblast growth factor (400 micrograms), or the vehicle alone, was injected into the ilium at 16 weeks after ovariectomy or a simulated operation. Bone mineral density in the ovariectomised rats increased to a level similar to the latter at 2 weeks and reached a maximum at 8 weeks. After 8 weeks, BMD decreased slowly and the value at 24 weeks was still higher than that in the ovariectomised rats. Fibroblast growth factor stimulated osteoid formation in the first 2 weeks, bone volume reaching a peak at 8 weeks. From 8 to 12 weeks, bone resorption increased, resulting in decreases in bone volume to the levels of the group with simulated operations at 24 weeks. Structural analysis at 8 and 24 weeks showed that ovariectomy decreased the continuity of trabeculae and the injection of fibroblast growth factor restored it to levels higher than, or equal to, those who had the simulated operation. The present study demonstrated that intraosseous fibroblast growth factor given to ovariectomised rats restored bone volume and quality to the levels of the rats who had a simulated operation only.
A 51 year-old man developed an extensive osteolytic response to wear debris in an uncemented porous-coated total hip arthroplasty, with metal/polyethylene interface, which had been implanted eighteen years previously. This reaction, which involved the upper femur and the ilium, produced a mass which compressed the pelvic viscera.
We report eight cases of osseous hydatidosis involving the pelvis and hip. All patients were treated by curettage and albendazole therapy. In three cases, in which only the ilium was involved, the outcome was satisfactory. The remaining patients required several debridement procedures in combination with chemotherapy and two developed chronic lesions. We conclude that treatment for this condition is difficult and when the osseous involvement is extensive the prognosis is poor.
We report a case of an obstructed pelvic kidney which was decompressed using a transosseous access route. The patient presented with obstructive uropathy and fever, necessitating decompression. Initial access was gained to the kidney by traversing the ilium, allowing subsequent retrograde placement of a double-J ureteric catheter.
Pluripotent mesenchymal stem cells in bone marrow differentiate to osteoblast progenitor cells. When the bone marrow cells are cultured in vitro, they form colony-forming units-fibroblastic (CFU-Fs) with exhibiting osteoblastic features such as expression of alkaline phosphatase (ALP) and formation of calcified nodules ex vivo. This article describes the effect of growth, maturation, and aging of the skeleton on human CFU-Fs harvested from human iliac bone marrow. Human bone marrow cells were harvested from the ilia of 49 women, and were cultured ex vivo for examination. The 49 subjects ranged in age from 4 to 88 years and were without metabolic bone disease. These aspirated bone marrow cells from human ilium exhibited osteoblastic phenotype such as alkaline phosphatase (ALP) activity, expression of osteocalcin (OSC) and parathyroid hormone-receptor (PTH-R) mRNA, and the formation of calcified nodules in vitro. The number of ALP-positive CFU-Fs and the ALP activity were quantified. The highest levels of ALP-positive CFU-Fs were observed in the young group, particularly in those under 10 years of age. The levels of ALP-positive CFU-Fs declined sharply after 10 years of age; those above 20 years of age exhibited a lower number of ALP-positive CFU-Fs, with a gradual decline with increasing age. These results indicate that change in the number of ALP-positive CFU-Fs may be associated with skeletal growth and maturation. The results also show that osteoblastic features such as ALP activity and capability of formation of calcification nodules were maintained even in the older subjects. These findings suggest that decreased activity of bone formation in the aged subjects could be, in part, caused by the decreased number of osteoprogenitor cells differentiating into osteoblasts because the number of ALP-positive CFU-Fs was one of the indices exhibiting bone-forming activity in the human marrow stromal cells.